The supplementary health insurance organizations (France Assureurs, the Mutualité Française and the CTIP Technical Center of Welfare Institutions) noted with some concern that the benefits had seriously slipped in 2023 and that the 2024 trend was also very unfavorable.
They have published several alerts in this regard (and here), which did not go unnoticed by the CNAM (National Health Insurance Fund) and the Ministry of Health.
For an external eye, it seems that the complementary blame the social security to disengage and this one forbids it. This may seem paradoxical since one could imagine that these complementary bodies would be satisfied with increased responsibility in health insurance.
In fact, the explanation of this apparent contradiction is actually deeper.
Compulsory health insurance is, in essence, an insurance for a ‘directed’ health pathway, that is to say, where the patient is directed towards standardised solutions. For example, if he has the choice of his attending physician, he is then strongly encouraged to consult him systematically as a priority (responsible course).
Complementary insurance is an insurance of choice, since you can choose products that better guarantee your care habits. It is also a more personalized insurance since it requires more specific advice and treatments. This therefore makes it, by nature, a more expensive insurance.
And the substance of the subject is therefore there: the imposed standardization of a certain number of guarantees (100% health, responsible contracts) makes complementary health care less legitimate on these guarantees since part of the pathways is ‘strongly encouraged’ . Moreover, the transfers of responsibility and the general increase in prices risk making complementary health services unpopular and could prepare the ground for the return of the ‘large security’ project. which would shift back a whole part of the activity of reimbursing supplementary benefits to the mandatory regime.
It is really this perspective that makes complementary health care nervously to see their rates go sideways.
Furthermore, it should be remembered that the ‘Grande sécurité’ would be a poisoned gift for the mandatory regime. Indeed, due to its standardization and the lack of customization, it is less well equipped than health supplements to effectively identify abuse of the system (‘ (… ) better fight against waste, abuse and fraud (…) ‘ mentioned in the open letter indicated above). It is therefore highly likely to face an increased problem of financing, which would be the opposite of the intended purpose of this project
However, everything indicates that the increase in health costs and especially an insufficiently careful reimbursement system have ended up attracting organized crime which has greatly improved in this field. All the actors have noticed an explosion of fraud recently, and particularly in 2023.
That is why it is essential that public authorities and complementary health organizations can cooperate much more closely on these issues. An example, among others, would be the disagreement and the much more active prosecution of unscrupulous health professionals.
Only in this way will the country be able to optimize its mixed system which, after all, has rendered many services.
